Surgical treatment for rebleeding caused by bypass failure after Rex shunt: re-Rex shunt or Warren shunt?
Surgical treatment for rebleeding caused by bypass failure after Rex shunt: re-Rex shunt or Warren shunt?
复制标题
Rex分流术后搭桥失败引起再出血的手术治疗：再Rex分流还是Warren分流？
DOI：
10.1007/s00383-018-4246-0
复制
发表时间：
2018-05-01
影响因子：
1.8
通讯作者：
Cheng, Wei
中科院分区：
文献类型：
--
作者：
Zhang, Jin-Shan;Li, Long;Cheng, Wei
虽然雷克斯分流术是治疗肝外门静脉阻塞（EHPVO）的有效方法，但术后仍有4-20%的患儿发生再出血。本研究旨在评价我中心雷克斯分流术后再出血的外科治疗，从2008年6月至2017年1月，我中心122例EHPVO患儿中有12例因雷克斯分流术后移植物狭窄和闭塞而接受了第二次手术。腹部超声和CT检查显示9例患儿旁路静脉闭塞，2例旁路静脉狭窄，1例肝内门静脉发育不良患儿旁路静脉通畅。8名儿童进行了Re-Rex分流术，其中1名儿童因术后再出血需要转为Warren分流术。5例患儿因术中门静脉造影和手术探查显示左门静脉狭窄而接受沃伦分流术。术后随访结果显示，Warren分流组术后再出血和食管静脉曲张发生率明显低于re-Rex分流组（P = 0.027和0.015）。二次手术后，Re-Rex分流术患儿的旁路静脉通畅率低于Warren分流术患儿（50 vs. 100%）。Warren分流术患儿术后脾体积缩小率明显高于re-雷克斯分流术患儿（P < 0.05），Warren分流术较re-雷克斯分流术更适合于治疗雷克斯分流术后转流失败再出血。
Although Rex shunt is an effective treatment for extrahepatic portal venous obstruction (EHPVO), 4-20% children develop rebleeding postoperatively. This study was used to evaluate the surgical treatment of rebleeding after Rex shunt in our center.From June 2008 to Jan 2017, 12 of 122 children with EHPVO underwent a second operation due to graft stenosis and occlusion after Rex shunt in our center. The abdominal ultrasound and computed tomography (CT) showed the occlusion of bypass vein in nine children, stenosis of bypass vein in two children, and the patency of bypass vein in one child with dysplasia of intrahepatic portal vein. A re-Rex shunt was performed in eight children, of which one child required conversion to Warren shunt due to postoperative rebleeding. Five children underwent Warren shunt due to a narrowed left portal vein shown by intraoperative portal angiography and surgical exploration. All patients were followed up in this study.The postoperative incidences of re-bleeding and esophageal varices in children with Warren shunt were significantly lower than those in children undergoing re-Rex shunt (P = 0.027 and 0.015). After a second operation, the rate of bypass vein patency in children with re-Rex shunt was lower than that in children with Warren shunt (50 vs. 100%). The postoperative reduced size of spleen in children undergoing Warren shunt was significantly higher than that of children undergoing re-Rex shunt (P < 0.05).Comparing to re-Rex shunt, Warren shunt was a better treatment for rebleeding caused by bypass failure after Rex shunt.